Smoking and Erectile Dysfunction

Summarized by Robert W. Griffith, MD
April 15, 2005

Introduction

Erectile dysfunction (ED) is not only distressing for the victim, it can also affect his partner's sexual gratification. Fortunately, drugs introduced over the last few years have brought relief to millions, and new research is aimed at helping those still afflicted. An important approach, however, is to determine the likely cause of someone's ED, and if possible remove it. Smoking has long been known as being associated with ED, and now Finnish researchers have looked at its effects both on the risk and long-term outcome of ED, and the effect of ED on smoking behavior. Their findings are published in the International Journal of Impotence Research, and we summarize them here.

What was done

The investigators selected groups of men born in 1924, 1934, and 1944 living in Tampere, Finland. Over 3000 of them were mailed questionnaires asking about lifestyle, medical conditions and their treatment, diet, exercise, and erectile problems. Five years later similar questionnaires were sent out to over 2800 men, including many of those from the first group.

After exclusion of people with missing data, those who had died, or who had moved from the area, as well as those who failed to complete the questionnaire properly, there were 1,442 men with full information for analysis.

ED was classified as 'none or minimal' vs. 'moderate or complete'. Smoking habits were classified as 'current smokers', 'ex-smokers' if they had stopped for the previous year or longer, and 'non-smokers' if they had never smoked or smoked for less than one year.

What was found

There were 312 men with ED, 1130 men without ED, 292 current smokers, 644 ex-smokers, and 502 non-smokers included in the baseline questionnaire.

A total of 203 of the 1130 men (18%) without ED developed it during the 5-year follow-up period. The likelihood of this happening increased with age; the likelihood (odds ratio) was 2.3 times for 60-65 year-olds and 4.5 times greater for 70-75 year-olds, compared with the younger age group - the 50-55 year-olds.

The likelihood of developing ED was also greater with smoking, but it was less pronounced than the age-effect; the likelihood was 1.4 times greater than that for non-smokers. This finding was not statistically significant, that is to say it might have occurred by chance alone.

The 312 men with ED were older and more often ex-smokers than the non-ED group. Sixty-one of them (20%) recovered erectile function spontaneously during the 5-year period; this was less likely with advancing age and with smokers (both current and ex-smokers).

A total of 43 men (15%) stopped smoking during the 5-year period; quitting was greater among older men and in those with ED.

Discussion

The findings of this study support the view that there's a clear link between smoking and ED. Smokers had a higher risk of ED and a lower recover rate than non-smokers. Quitting smoking was greater among smokers, suggesting that the 'news is getting through' - quitting is likely to help reverse ED.

The authors of the study make considerable play of the apparent effect of ED on smoking, but only 15 (4%) of the 502 nonsmokers at baseline started smoking; the apparent risk of starting smoking was higher in men with ED, but the numbers are very small and, as such, are inconclusive.

The importance of this study lies in its prospective nature, i.e. the subjects were selected some time ago, a baseline was established, and subjects were then followed for a period. This sort of study is considered to carry far more weight than one that's a look at associations between different factors at a single point in time - a so-called cross-sectional study. There's a weakness, however, in the present study - some of the men included in the second round of questionnaires hadn't received a baseline questionnaire.

There are plenty of good reasons not to smoke, and to stop smoking if you already do so. In some countries, anti-tobacco advertisements feature the risk of ED as a reason not to smoke. While it's certainly not the main health reason, it can be a persuasive one for men anxious about the loss of their sexual potency.

Source

• Relationship between smoking and erectile dysfunction. R. Shiri, M. Hakama, J. Hakkinen,  et al., Int J Impot Res, 2005, vol. 17, pp. 164--169

Related Links
Exercise to Fight Erectile Dysfunction
Premature Ejaculation - A Fact Sheet

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